Maximum hepatitis cases in state due to drug addiction

Manav Mander

Tribune News Service

Ludhiana, July 27

The primary cause of the spread of hepatitis C virus (HCV) is unscreened blood during transfusions, unsafe surgical practices and unsafe therapeutic injections such as those used by diabetics. But in Punjab, the spread through drug addiction and its associated causes have come out to be the major reason behind the spread of hepatitis C.

“Use of injection needs to be taken care of. The way unsterile needles are being used by intravenous drug users is how the infection is spreading at an alarming rate. It has been observed that doctors in rural areas are re-using injections which are leading to hepatitis C cases,” said Dr Dinesh Gupta, head of gastroenterology and haematology department at Deepak Hospital.

Secondary causes include sharing personal-care items such as toothbrushes and razors with a person infected with the virus. It also may get transmitted through unprotected sex, he said.

Dr Vikramjeet S Sandhu from gastroenterology department of SPS Hospital said sharing infected needles/syringes by drug addicts is the major source of HCV transmission in the state now. Tattooing and body piercing, sharing razors and toothbrushes, recipient of unscreened blood /blood products, haemodialysis patients and HIV infected persons are at an increased risk of getting infected by hepatitis C.

“Hepatitis C is dangerous due to its asymptomatic nature. The infection often remains silent inside the body for several years and exhibits symptoms only when it reaches the chronic stage. This makes its detection difficult. Although, there is no vaccination for the infection, there are several generic drugs that have made disease curable,” he said.

Hepatitis C cases are on the rise. Hepatitis B can be transmitted from a mother to her baby or through sexual intercourse as well, while chances of transmission of HCV are comparatively less. Hepatitis A and E are transmitted through water contamination. Doctors suggest drinking clean water and even screening of blood, sterilised needles and syringes to stop progression of the virus.

In the long term, HCV can lead to liver disease and cirrhosis, which is the reason it is a big concern.

“About 15-20%of HCF-infected patients suffer from advanced liver disease due to HCV virus, while 3-4%of patients with advanced liver disease develop cancer due to the virus, every year,” says Dr Gupta. “The consumption of alcohol enhances liver disease caused by HCV. Similarly, fatty liver and co-infection with other viruses such as HBV virus and the HIV virus aggravates liver disease,” he said. The virus doesn’t cause many symptoms in the initial phase. Symptoms may be non-specific such as fatigue, discomfort in the right side of the abdomen and lethargy. However, once the liver gets damaged (cirrhosis) then patients may have jaundice, ascites (fluid accumulation in the abdominal cavity), GI bleed, and even the development of liver cancer.

Dr NS Malhi, senior consultant and head of gastroenterology department at SPS Hospital, said the main cause of the spread of hepatitis C in Punjab is sharing of infected needles by intravenous drug users. High rate of drug abuse and the subsequent practice of sharing needles has emerged as the prime cause behind the spread of infection in the region,” says Dr Malhi.

The observation falls in line with the results of a recent Punjab Opioid Dependence Survey, which estimated that there are 2,32,856 opioid drug users in the state, of which at least one-third use the injectable method to administer drugs.

What is hepatitis?

Hepatitis or inflammation of the liver is of five kinds — A, B, C, D, and E. Hepatitis A and E virus is transmitted through contaminated water and food, while Hepatitis B and C are communicated through blood and body secretions. The initial symptoms of the infection resemble that of common flu. While hepatitis A is the most common form of hepatitis, hepatitis B and C are the deadliest. Prevalence of Hepatitis B is 3-5 per cent, while hepatitis C is 1 per cent in general population in India. Hepatitis infections can be prevented.

Prevention of hepatitis B and C involves practices to prevent contact with infected blood or semen. Using condoms, strictly avoiding sharing of needles or razors, and making sure tattooing or body piercing is done using clean tools.

Who is at risk of getting hepatitis C?

Anyone who has been exposed to the blood of an infected person is at risk of having hepatitis C. You should talk to a doctor about getting tested for the disease if you:

• Ever used illegal intravenous drugs or cocaine
• Received a blood transfusion or organ transplant prior to 1996
• Received long-term haemodialysis
• Have persistently abnormal ALT (SGPT) levels
• Were born to an HCV-infected mother
• Have had unprotected sex with multiple partners
• Received tattoos or body piercings with unsterile needles, especially in an unregulated setting
• Have household exposure, by sharing razors, toothbrushes or other personal items with an HCV infected person

Mukh Mantri relief fund — A ray of hope for patients 

Mukh Mantri Punjab Hepatitis C Relief Fund has come to the rescue of patients suffering from Hepatitis C. The scheme was started in the last week of June and Punjab is the first state to provide treatment free of cost to the patients diagnosed with Hepatitis C. Till now, 187 patients are availing the benefits of the scheme.

Dr Renu, a civil surgeon, said the patients suffering from Hepatitis C were given treatment free of cost under the scheme. “We have tied up with a laboratory and the test of the patient is done at a subsidised rate. If the patient tests positive, his/her treatment is done free of cost. All medicines are given free of cost since the medicines for the treatment are very costly,” she said.

Dr Munir, district epidemiologist, Integrated Disease Surveillance Programme (IDSP) said the scheme was started in the last week of June and 187 patients from Ludhiana district were undergoing treatment for hepatitis C till date.

A patient who is undergoing treatment for Hepatitis C at the Civil Hospital said he was diagnosed with hepatitis C but was unable to continue the treatment due to costly medicines. “Somebody told me that the treatment for Hepatitis C is done free of cost at the Civil Hospital. It was then I came here and I am getting medicines free of cost which otherwise I could not afford,” he said. The Punjab government has initiated the Mukh Mantri Punjab Hepatitis C Relief Fund with an initial contribution of Rs 20 crore. Treatment for Hepatitis C is provided free of cost to the patients at the state government medical colleges of Patiala, Amritsar and Faridkot, besides 22 district hospitals.

Hospitals spread awareness, hold free screening camps

World Hepatitis Day was observed by various hospitals today. The theme this year is “Know Hepatitis - Act now”. 

SPS Hospitals

The department of gastroenterology at SPS Hospitals organised a week-long free screening camp on World Hepatitis Day, where more than 600 people were screened.Dr Amit Soni, gastroenterologist at SPS Hospitals, said hepatitis C was still one of the commonest causes of liver damage and liver cancer in Punjab. 

Deep Hospital

Deep Hospital also observed World Hepatitis Day by organising a free screening camp for Hepatitis B and Hepatitis C. A Total of 250 patients were screened and patients were provided counselling. 

Lifeline Hospital

The day was also observed by Lifeline Hospital. Patients who have been treated of the disease were also invited by the hospital today. Doctors said by 2030, the disease would become fatal and prevention was better than cure.